10-13-2017, 03:33 AM
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I am having trouble determining the correct ICD-10 diagnosis code(s) for "Radiation soft tissue injury of the brain". One of my providers is treating a patient for this condition with hyperbaric oxygen therapy. He also refers to the condition as "Radiation therapy induced brain necrosis". I have done a lot of research and the choices seem to come down to L59.8- Other specified disorders of the skin and subcutaneous tissue related to radiation and a combination of I67.89- Other cerebrovascular disease and Y84.2-Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure. I do know that brain radionecrosis is considered a covered dx for hyperbaric treatment by some payers, but I67.89 and Y84.2 do not seem to be covered on the NCD. On the other hand, L59.8 is covered by the NCD, but I am not sure that diagnosis pertains to the brain. There is also T66.XXXA- Radiation sickness, unspecified, initial encounter, but that doesn't seem specific enough and is also not covered by the NCD. I have been going in circles with this for a while now. Any and all help is VERY much appreciated. Thank you!!!

In order to get the claim paid I believe you could use an injury code from Chapter 19....S06.890A (other specified intracranial injury without loss of consciousness, initial encounter). I would also include the I67.89 and Y84.2

In order to get the claim paid I believe you could use an injury code from Chapter 19....S06.890A (other specified intracranial injury without loss of consciousness, initial encounter). I would also include the I67.89 and Y84.2

If all else fails- Appeal the claim with the supporting documentation

Good Luck!

Megan Spires, CPC, CFPC

Thank you for your reply! I'm afraid S06.890A is not supported by the NCD for hyperbaric oxygen therapy. There are a very limited amount of diagnoses that will support medical necessity for hyperbaric. You're right though, as it may just come down to the appeals with documentation.

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